No, the title does not refer to sex, a Ferrari, a promotion, or winning the lottery. It’s a quote from Dr. Robert Nam from Toronto’s Sunnybrook Health Sciences Centre about the number of applicants for a clinical study of using 3T MRI to screen for prostate cancer (PCa).[i] There were 50 openings, but 300 applicants. According to the news report, the study team was astounded since the terms of participation included a mandatory prostate biopsy and no financial compensation.
What does this mean? To me, it means that there is broad awareness that PSA screening for prostate cancer is greatly flawed. The two biggest problems are
- It is not specific for prostate cancer since many benign conditions or activities can elevate PSA, and
- A high PSA value all too often leads to a prostate biopsy – and we know that this intrusive procedure overdetects insignificant disease and underdetects significant disease.
So why turn to magnetic resonance imaging, which is more costly in the short term than a simple blood test? Let’s look at the results from Dr. Nam’s team.
Of the fifty men who enrolled, full results were available for 47 of them. Eighteen (38.3%) had PCa while 29 (61.7%) showed no signs of it. Each of the patients had no known family history. Following imaging and a PSA blood test, all of them had a biopsy. The results showed that the MRI was almost three times more successful than PSA at diagnosing PCa. Furthermore, it was superior at predicting significant (aggressive) disease. In addition, said Dr. Nam, “”Patients are willing to undergo MRI and patients are willing to rely on the MRI to guide treatment. This study was so important that the team has launched a comparison study between MRI and PSA, with equally enthusiastic enrollment.
Let’s return to the notion that MRI is too expensive to use as a screening tool. At first glance, this would seem obvious. However, doing the math shows that over the longer term, the cumulative cost of 1) prostate biopsies, 2) repeat prostate biopsies after false negative results from earlier biopsies, 3) side effects of conventional biopsies (infection, ED, hospitalization) and 4) overtreatment for insignificant PCa – as well as managing those side effects – actually outweigh the price of a single but accurate MRI. Based on those results, a biopsy can be ruled in or out; if treatment is needed, the MRI is the single greatest tool for treatment planning, and focal treatment for properly qualified patients can potentially save the medical system untold dollars each year.
This study and the future studies that come as a result are thrilling. Men and their loved ones deserve a screening tool that eliminates ambiguous, anxiety-producing results while reducing the number of invasive, damaging procedures. Congratulations to Dr. Nam and his team for pointing prostate cancer detection in the right direction.
[i] Nick Mulcahy. “MRI is ‘Feasible’ Prostate Cancer Screening Test.” Medscape Urology, July 19, 2016. http://www.medscape.com/viewarticle/866344
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
